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The Executive Guide to Healthcare Kaizen: Leadership for a Continuously Learning and Improving Organization

The Executive Guide to Healthcare Kaizen: Leadership for a Continuously Learning and Improving Organization

by Mark Graban, Joseph E. Swartz


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Hospitals and health systems are facing many challenges, including shrinking reimbursements and the need to improve patient safety and quality. A growing number of healthcare organizations are turning to the Lean management system as an alternative to traditional cost cutting and layoffs. "Kaizen," which is translated from Japanese as "good change" or "change for the better," is a core pillar of the Lean strategy for today’s best healthcare organizations.

Kaizen is a powerful approach for creating a continuously learning and continuously improving organizations. A Kaizen culture leads to everyday actions that improve patient care and create better workplaces, while improving the organization’s long-term bottom line. The Executive Guide to Healthcare Kaizen is the perfect introduction to executives and leaders who want to create and support this culture of continuous improvement.

The Executive Guide to Healthcare Kaizen is an introduction to kaizen principles and an overview of the leadership behaviors and mindsets required to create a kaizen culture or a culture of continuous improvement. The book is specifically written for busy C-level executives, vice presidents, directors, and managers who need to understand the power of this methodology.

The Executive Guide to Healthcare Kaizen shares real and practical examples and stories from leading healthcare organizations, including Franciscan St. Francis Health System, located in Indiana. Franciscan St. Francis’ employees and physicians have implemented and documented 4,000 Kaizen improvements each of the last three years, resulting in millions of dollars in hard savings and softer benefits for patients and staff.

Chapters cover topics such as the need for Kaizen, different types of Kaizen (including Rapid Improvement Events and daily Kaizen), creating a Kaizen culture, practical methods for facilitating Kaizen improvements, the role of senior leaders and other leaders in Kaizen, and creating an organization-wide Kaizen program.

The book contains a new introduction by Gary Kaplan, MD, CEO of Virginia Mason Medical Center in Seattle, Washington, which was named "Hospital of the Decade" in 2012.

The Executive Guide to Healthcare Kaizen is a companion book to the larger book Healthcare Kaizen: Engaging Front-Line Staff in Sustainable Continuous Improvements (2012). Healthcare Kaizen is a longer, more complete "how to" guide that includes over 200 full color images, including over 100 real kaizen examples from various health systems around the world. Healthcare Kaizen was named a recipient of the prestigious Shingo Professional Publication and Research Award.

Check out what the experts at the Franciscan St. Francis Health System have to say about Healthcare Kaizen.

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Product Details

ISBN-13: 9781466586413
Publisher: Taylor & Francis
Publication date: 08/21/2013
Pages: 200
Product dimensions: 5.90(w) x 9.20(h) x 0.50(d)

About the Author

Mark Graban is an author, consultant, and speaker in the field of lean healthcare. He is the author of Lean Hospitals: Improving Quality, Patient Safety, and Employee Engagement (2nd Edition) and co-author of Healthcare Kaizen: Engaging Front-Line Staff in Sustainable Continuous Improvements. Mark has worked as a consultant and coach to healthcare organizations throughout North America and Europe. He was formerly a senior fellow with the Lean Enterprise Institute and continues to serve as a faculty member. Mark is also the Chief Improvement Officer for KaiNexus, a startup software company that helps healthcare organizations manage continuous improvement efforts. Mark earned a BS in Industrial Engineering from Northwestern University and an MS in Mechanical Engineering and an MBA from MIT Sloan Leaders for Global Operations Program. Visit his website at and his blog at

Joseph E. Swartz is the Director of Business Transformation for Franciscan St. Francis Health of Indianapolis, IN. He has been leading continuous improvement efforts for 18 years, including 7 years in healthcare, and has led more than 200 Lean and Six Sigma improvement projects. Joseph is the co-author with Mark Graban of Healthcare Kaizen: Engaging Front-Line Staff in Sustainable Continuous Improvement and co-author of Seeing David in the Stone and was previously an instructor at the University of Wisconsin. Joseph earned an MS in Management from Purdue University as a Karnnert Scholar for academic excellence.

Table of Contents

The Need for Kaizen
Quick Take
Kaizen = Change for the Better
Kaizen = Meaningful Improvements
Healthcare’s Opportunity for Improvement
The IOM’s Recommendations for Continuous Learning
Dr. Berwick’s Early Call for Kaizen in Healthcare
The Impact of Kaizen at Franciscan St. Francis
It Is Not Always about Cost
The Business Case for Kaizen
Lower Staff Turnover Costs
Cost Reductions and Hard Savings
Higher Revenue and Patient Throughput
Cost Avoidance and Soft Savings
Improved Quality and Patient Safety
Improvements Have Interwoven Results
What Executives Need to Do
Creating a Management Operating System
Tying Kaizen to Strategy
Connecting Kaizen to the Mission
Discussion Questions

What Is Kaizen?
Quick Take
Bubbles for Babies
Kaizen = Continuous Improvement
Kaizen Is Not Just Change, It Is Improvement
Kaizen Starts with Small Changes
A Small Kaizen with Great Meaning
Kaizen Involves the People Who Do the Work
Kaizen, PDSA, and the Scientific Method for Improvement
We Often Succeed as the Result of Failing More
"Failure" Should Result in Learning
Changing Back Can Be Better for Babies
Kaizen Is Not a Suggestion System—It Is an Improvement System
Common Dysfunctions of Suggestion Systems
Suggestion Boxes Are Rarely or Never Opened
Suggestion Box Systems Are Slow, with Poor Feedback
Too Many Suggestions Are Rejected or Ignored
Suggestion Systems Put the Burden on Managers
Winner Takes All Demoralizes the Rest
Suggestion Bonuses Cause More Trouble than They Are Worth
Kaizen and Lean
Kaizen: One of the Two Pillars of The Toyota Way and Lean
Respect for People = No Layoffs Due to Kaizen
Kaizen and Respect Are Intertwined
Kaizen Closes Gaps between Staff and Leaders
Kaizen Values Creativity before Capital
Kaizen Helps Avoid Expensive Mistakes
Kaizen Reignites Our Inherent Creativity
People Are the Ultimate Competitive Advantage
Discussion Questions

Types of Kaizen
Quick Take
The Continuous Improvement of a Lifesaving Innovation
Kaizen Means Continuous Improvement or Just Projects?
Three Levels of Kaizen
Large Projects
Mid-Sized Projects
Smaller, Daily Improvements
Complementary Nature of the Levels of Kaizen
Three Types of Kaizen at Children’s Medical Center Dallas
Events Are Powerful, but Not Enough
Basic Structure and Format of an Improvement Event
Additional Challenges with Weeklong Events
Combining Different Types of Kaizen
Virginia Mason Medical Center
Avera McKennan
Kaizen Leads to Innovation at Franciscan
Discussion Questions

Creating a Kaizen Culture
Quick Take
Everyone Is Part of the Change Culture
The Real Goal—Cultural Transformation
Kaizen Grows Skills and Abilities
Barriers to Kaizen
Resistance to Change
Lack of Time—We’re Too Busy
What a Kaizen Culture Feels Like
Everyone Is Engaged
Drivers of Engagement
Everyone Is Relentlessly Searching for Opportunities to Improve
Patients and Families Are Happy
Staff and Physicians Are Engaged
The Workspace Is Clean, Orderly, and Safe
Everyone Works Together
Everything Gets Questioned
Small Successes Lead to Bigger Successes
Imai’s Three Stages of a Kaizen Culture
Discussion Questions

Daily Kaizen Methods
Quick Take
Fresh Eyes Can See Waste That Hid before Your Eyes
The 5 Steps of Kaizen
Step 1: Find
Start Small
Step 2: Discuss
Say "Yes"
Coaches for Coaches
Step 3: Implement
Seven Days Grace
Step 4: Document
Quantifying Benefits When Possible
Step 5: Share
Sharing Kaizens: Kaizen Reports and the Kaizen Wall of Fame
Visual Idea Boards: Making the Entire Kaizen Visible
Idea Cards
Electronic Kaizen Systems: Making Kaizen More Broadly Visible
Advantages of an Electronic Online Database
Quick Entry and Categorization
Automatic Routing and Electronic Communication
Quick Search and Retrieval
Electronic Kaizen within Intermountain Healthcare
Electronic Kaizen at Vanderbilt
Discussion Questions

The Role of Senior Leaders in Kaizen
Quick Take
The Reluctant CEO
Key Actions for Leaders at All Levels
Key Action 1: Believe in the Power of Kaizen
Key Action 2: Participate in Kaizen
Key Action 3: Just Ask
Ask, Don’t Tell
Key Action 4: Use Kaizen to Develop People
Key Action 5: Ensure Staff Members Are Recognized and Rewarded
Key Action 6: Share and Spread Ideas
Key Action 7: Sell the Benefits
The Specific Role of Senior Leaders
Leadership and Kaizen Participation Starts at the Top
Going to the Gemba
Key Actions for Senior Leaders
Key Action 1: Communicate Expectations, Prioritize, and Set Direction
Key Action 2: Ensure Adequate Resources Are Available
Key Action 3: Sponsor a Recognition and Incentives Program
Key Action 4: Share Notable Kaizens
Key Action 5: Thank People Personally
Discussion Questions

The Role of Other Leaders in Kaizen
Quick Take
From Cop to Coach
Kaizen Requires Leaders at All Levels
Role of Middle-Level Managers
Paula’s Baby Steps Lead the Way
The "Great Big Pile of Problems"
Key Actions for Middle-Level Managers
Key Action 1: Be the Departmental Owner and Develop Co-Owners or Coordinators
Key Action 2: Use Departmental Meetings
Key Action 3: Encourage Staff to Participate by Asking for Their Ideas
Key Action 4: Create a Departmental Recognition System
Key Action 5: Put a Tracking System in Place, if One Does Not Exist
Key Action 6: Tie to Performance Evaluations
Role of First-Level Managers
Key Actions for First-Level Managers
Key Action 1: Coach
Key Action 2: Empower Staff—Do Not Do the Kaizen for Them
Key Action 3: Use Rounding to Coach
Key Action 4: Help Set Expectations
Key Action 5: Review and Approve Kaizen Reports
Key Action 6: Help Document Benefits
Key Action 7: Make Kaizen Fun
Key Action 8: Recognize and Reward
Key Action 9: Share and Spread Ideas
Key Action 10: Be a Cheerleader
Leaders Drive Kaizen Success
Discussion Questions

Organization-Wide Kaizen Programs
Quick Take
From Helplessness to Empowerment
From One Department to the Whole Organization
Getting Started
Starting Small and Spreading Kaizen
When Will You See Results?
Tying Kaizen to the Organization’s Strategy
The Kaizen Promotion Office
Staffing the KPO
Activities of the Kaizen Promotion Office
Activity 1: Facilitates the Practice of Kaizen
Activity 2: Reports Kaizen Metrics
Activity 3: Coordinates Rewards and Recognition
Activity 4: Facilitates Kaizen Sharing across the Organization
Activity 5: Develops Kaizen Standardized Work
Activity 6: Develops and Delivers Staff Education
Activity 7: Facilitates the Documentation and Tracking of Kaizens
Sustaining a Kaizen Program: Incentives and Rewards
Pros and Cons of Financial Incentives
Discussion Questions

Small Methods Lead to a Meaningful Impact
Tools and Philosophies
Building the Culture
A Minute to Learn, a Lifetime to Master
Building upon Franciscan’s Success
Your Next Steps
Building a Kaizen Community

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